Haggling over health rules begins

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A Senate report singled out insurance company WellPoint for shifting costs to raise its medical loss ratio in order to comply with the new law.
AP Photo

WellPoint does not dispute reclassifying some previously administrative costs. But it says the costs reclassified, which included a nurse hotline and expenditures on a clinical health policy, fell well within the bounds of the proposed health care regulations, which allow “activities that improve health quality” to be counted as medical.

“We reclassified costs that are incurred to improve our members’ health and medical outcomes, and this is appropriate accounting treatment,” said WellPoint spokeswoman Kristin Binns. “We did not reclassify costs for network contracting, claims or customer service. In fact, we selected benefits that have been discussed as being part of the Medical Costs Ratio calculation in the various federal health reform proposals in an effort to be consistent with them.”

Insurance companies will help develop and comply with new medical loss ratio regulations. Robert Zirkelbach, communications director of industry group America’s Health Insurance Plans, says they “support transparency” when it comes to explaining how premiums are spent. But he also describes the new numbers as “arbitrary” and not based on any current industry practices.

The process highlights tensions between insurance companies and government officials tasked with regulating them.

A Senate aide familiar with the issue recalls “enormous pushback” from some insurers to requests for medical loss ratio information. “It was striking,” the aide said, “given how much they relied on that data for their analysts.”

The National Association of Insurance Commissioners, a consortium of state-level officials, is supposed to play middleman between legislators and insurers.

In the Affordable Care Act, the Department of Health and Human Services designated NAIC as the agency that would draft definitions and regulations of the medical loss ratio provisions.

NAIC currently has two task forces at work on the issue, both holding weekly conference calls and circulating numerous proposals and calls for input.

One recent phone call, attended by POLITICO, attracted insurance commissioners, consumer advocates and insurers. All discussed the best way to calculate a medical loss ratio.

Public comment on the medical loss ratio provision closes May 14 and, by the end of the month, NAIC will submit a first draft of guidelines to the Department of Health and Human Services.

“Ultimately, our process is pretty objective,” said Kim Holland, NAIC secretary and treasurer, who is Oklahoma’s insurance commissioner. At the end of the day, she says, complicated areas of insurance policy are regulated in the same way as simpler provisions: “We’ll develop a standard, require insurers to meet it, and, if they don’t, they will get sanctioned.”

Only the government could make it that complicated. Leave it up to the government to blur the lines of care. If consumers were to take charge of the cost of their individual care they would act responsibly and make informed decisions based on their circumstance and needs..

What a surprise. Can't intrepret the HC bill? I think the should ask Pelosi and Reid I am sure the voted for the bill before they read it. Pretty Slimy. Seem just like all bills from Congress the loopholes will ruin it and we will need a committee to investigate (I recommend Waxman and Boxer before they get booted out for their obvious lack of sense) As a way to control the HC costs ask Obama to declare a National Emergency, lock uo the WH secretary guests to WH under National Emergency lists, sign an executive order (have Stupak co sign it) Invite Geithner and his Turbo Tax to figure out new costs, Nepalitano to close the doors of the hospitals (has ICE to use as not used on border) have Holder investigate the fraud (Ha Ha Ha Ha--use the attorneys in the WH filing their fingernails waiting for the terrorist trials, get the speech makers going so Obama can get on TV and debate Leno, If all else fails, cut out our oil drilling, the US will freeze over and Obama and Congress can walk on water. Disgusted!!

The most important point is that government death panels will decide if you are worth a heart transplant. They will decide if that treatment is Necessary, or Useful, or Justified in your case. And you are all for it because you trust Government.

why even pretend. The answer is going to be something like "life threatening until the state decides that you are too old or disabled to live". That's what they want, and short of repeal, that's what will happen. If you're disabled or over 80, you are supposed to "die with dignity" so as not to burden the state.

I am shocked -- I say shocked -- to find out that this is all a lot more complicated than our illustrious lawmakers led us to believe.

One week they are passing 1,000 pages of rules governing how health care will be provided. The next week they seek to remake our financial markets. When they finish with that they will design a new energy delivery system for a country of 350 million people.

Either these are the smartest, most learned 535 people in the history of the world, or we are being bamboozled by a bunch of corrupt blowhards who don't and can't have the slightest idea what they are doing from one day to the next.

(I recommend Waxman and Boxer before they get booted out for their obvious lack of sense

Boxer...the one that equated tax money paying for Viagra to paying for abortion. I was going to show a picture of both to make my point but the pictures of the aborted babies were just to sad and graphic however.....if you want to see for yourself if barbie was right and the taxpayers to should pay for abortion.......here is a link.

Just another sad news. There are several instances Insurance companies play under-hand tactics to nullify genuine compensation claims. Most of the insurance companies are less inclined towards helping people in distress. Instead their sole focus is to always find loop-holes in the medical claims.